Right Heart Strain on Presenting 12-Lead Electrocardiogram Predicts Critical Illness in COVID-19

Raad, Mohamad; Gorgis, Sarah; Dabbagh, Mohammed; Chehab, Omar; Parikh, Sachin; Singh, Gurjit

Background Cardiovascular comorbidities and complications, including right ventricular dysfunction, are common and are associated with worse outcomes in patients with COVID-19. The data on the clinical utility of 12-lead electrocardiograms (ECG) to aid with prognosis is limited. Objectives We aim to assess the association of new right heart strain patterns on presenting 12-lead electrocardiogram (RHS-ECG) with outcomes in patients hospitalized with COVID-19. Methods We retrospectively evaluated records from 480 patients who were consecutively admitted with COVID-19. ECGs obtained at the time of presentation in the emergency department (ED) were considered as index ECGs. RHS-ECG was defined by any new right axis deviation, S1Q3T3 pattern, or ST depressions with T-wave inversions in leads V1-3 or II, III, aVF. Multivariable logistic regression was performed to assess whether RHS-ECG is independently associated with our primary outcomes. Results ECGs from the ED were available for 314 patients who were included in the analysis. Most patients were in sinus rhythm, with sinus tachycardia being the most frequent dysrhythmia. RHS-ECG findings were present in 40 (11%) patients. RHS-ECG was significantly associated with the incidence of adverse outcomes and an independent predictor of mortality (adjOR, 15.2 (95% [CI, 5.1-45.2]; P<0.001), the need for mechanical ventilation (adjOR, 8.8 [95% CI, 3.4-23.2]; P<0.001), and their composite (adjOR, 12.1 [95% CI, 4.3-33.9]; P<0.001). Conclusions RHS-ECG was associated with mechanical ventilation and mortality in patients admitted with COVID-19. Special attention should be taken in patients admitted with new signs of RHS on presenting ECG